Heterogeneity in the effect of public health insurance on medical care utilization and financial risk protection: Evidence from Ghana

Abstract:
Universal health coverage requires that families have access to quality health services appropriate to their needs without suffering financial catastrophe. In Ghana, the National Health Insurance Scheme (NHIS) aims to improve access to health services unconditioned by capacity to pay. Our study uses the Ghana Living Standards Survey collected in 2012-2013 to evaluate the impact of health insurance on medical care utilization and financial risk protection ten years after the introduction of the NHIS. Our findings reveal that health insurance improved medical care utilization at the individual-level while protecting from immiserizing and catastrophic health expenditure at the household-level. Participation in the NHIS increased the probability of meeting medical needs in the general population by 15%, decreased the burden of immiserizing out-of-pocket (OOP) payments on the precarious consumption of households below the poverty line by 31% and amounted to a 31% reduction of catastrophic OOP spending among households above the poverty line. Notwithstanding impressive progress, there are considerable opportunities for improvement, particularly with regards to ensuring that marginalized populations benefit equally from participating in the NHIS. Although NHIS coverage has substantially increased service utilization in the general population, our findings reveal significant effect heterogeneity across subpopulations. These findings support the UHC objective of the Ghanaian NHIS and offers valuable lessons to low- and middle-income countries with hard-to-serve rural populations seeking to broaden access to quality healthcare while lessening reliance on OOP payments.